title: Introduction of enteral feeding in neonates on extracorporeal membrane oxygenation after evaluation of intestinal permeability changes.
abstract: OBJECTIVE
  Neonates meeting criteria for extracorporeal membrane oxygenation (ECMO) often suffer from variable periods of hypoxia. During ECMO, starvation of the gut is common practice in many centres as splanchnic ischemia results in loss of intestinal integrity, which in turn predisposes for bacterial translocation and sepsis and eventually necrotizing enterocolitis (NEC) and multiorgan failure. However, minimal enteral feeding is thought to be of benefit in the critically ill. Data on intestinal integrity in newborns on ECMO and the effects of enteral nutrition are not available. This study prospectively evaluates the changes in small intestinal integrity in 16 neonatal ECMO patients.
  
  
  METHODS
  With 2-day intervals, excretion percentages of lactulose/L-rhamnose (nonmediated diffusion), D-xylose (passive), and 3-O-methyl-D-glucose (active carrier-mediated transport) were measured by gas-liquid chromatography in a 4-hour urine sample. After obtaining baseline data in nine patients, enteral feeding was started in the next seven patients between the third and the ninth day of ECMO.
  
  
  RESULTS
  Thirteen patients had increased lactulose/L-rhamnose ratios (>0.05) consistent with increased intestinal permeability. In three patients the lactulose/L-rhamnose ratios were within the normal range. D-xylose excretion percentages were normal (or slightly increased) in 11 patients consistent with normal (or increased) passive carrier-mediated transport. 3-O-methyl-D-glucose excretion percentages were decreased (<10%) in all but one patient, consistent with decreased active carrier-mediated transport. After introduction of enteral nutrition no significant changes of these parameters were seen.
  
  
  CONCLUSIONS
  The authors conclude that intestinal integrity is compromised in neonates on ECMO and that introduction of enteral nutrition does not result in further deterioration. This conclusion does not support the practice of withholding enteral nutrition in critically ill newborns supported by ECMO.
authors.affiliation: Department of Pediatric Surgery, University Hospital/Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Piena
authors.forename: M J
authors.initials: MJ
authors.lastname: Albers
authors.forename: P M
authors.initials: PM
authors.lastname: Van Haard
authors.forename: S
authors.initials: S
authors.lastname: Gischler
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D019325:3-O-Methylglucose / Q000493:pharmacokinetics / Q000652:urine; D001692:Biological Transport / Q000502:physiology; D002851:Chromatography, High Pressure Liquid; D004750:Enteral Nutrition; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007231:Infant, Newborn; D007408:Intestinal Absorption / Q000502:physiology*; D007792:Lactulose / Q000493:pharmacokinetics / Q000652:urine; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D012210:Rhamnose / Q000493:pharmacokinetics / Q000652:urine; D013997:Time Factors; D014994:Xylose / Q000493:pharmacokinetics / Q000652:urine
chemical_list: D019325:3-O-Methylglucose; D007792:Lactulose; D014994:Xylose; D012210:Rhamnose